ASCs Save Billions for Medicare

Surgery centers saved the Medicare program $7.5 billion between 2008 and 2011, and could contribute to more than $57 billion in additional savings over the next decade, according to a University of California-Berkeley study.

Researchers at the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare set out to determine how much the Medicare program and its beneficiaries save when procedures are performed at ASCs instead of HOPDs, and how much those savings would grow if more procedures migrated to ASCs in the future.

Their analysis of procedures performed in both settings, corresponding reimbursement rates and the predicted number of Medicare beneficiaries from 2013 to 2022 revealed that:

  • During the 4-year period from 2008 to 2011, because ASCs are paid an average of 58% of the HOPD reimbursement rate, surgery centers generated a total of $7.5 billion in savings for the Medicare program and its beneficiaries.
  • The savings increased each year, rising from $1.5 billion in 2008 to $2.3 billion in 2011. This increase resulted from the total number of overall surgical procedures growing from 20.4 million to 24.7 million between 2008 and 2011, as well as from the widening reimbursement rate gap between HOPDs and ASCs. Additionally, the savings were realized despite the share of total Medicare procedures performed in ASCs decreasing from 22.9% in 2008 to 21.7% in 2011.
  • If ASCs' share of procedures or Medicare procedure volume remain constant over the next decade, surgery centers will save the Medicare program an additional $32.5 billion. However, if ASCs' share of procedures increases even slightly, the savings could exceed $57.6 billion over 10 years.

ASC Association CEO William Prentice says surgery center growth has stalled, and some centers are being purchased by hospitals and turned into HOPDs. Those factors are limiting the cost-saving potential of ASCs, he says, adding, "Congress and the Obama administration must ensure that Medicare payments for ASC services are sufficient so that ASCs can continue to be the lower-cost alternative for outpatient surgical care for America's seniors."

Daniel Cook

Obstructive Sleep Apnea Can Persist Despite Procedure

Young children who undergo adenotonsillectomies to treat obstructive sleep apnea aren't necessarily cured of the condition as a result, a study published in JAMA Otolaryngology — Head & Neck Surgery suggests.

Researchers at the University of Chicago reviewed the records of 70 patients aged 3 years or younger who had both pre-operative and post-operative polysomnograms. Though their conditions improved markedly on the whole, 15 of the 70 (21%) had residual OSA.

The more severe the pre-operative OSA was, the more likely the condition would persist, the researchers hypothesized. They added, however, that their findings were limited because their study was retrospective and only 25% of the 283 patients reviewed had both pre- and post-operative polysomnograms.

Jim Burger

Double Trouble with Multi-Drug Resistant Organism

That which does not kill microbes in healthcare settings may make them stronger, according to a pair of British researchers, who found that bacteria that survive surface disinfection can develop antibiotic resistance.

For a preliminary proof-of-concept study presented at the recent Interscience Conference on Antimicrobial Agents and Chemotherapy in Denver, researchers from Nottingham Trent University cultured 43 strains of Acinetobacter with the disinfectants Trigene or Hycolin, or with the antibiotic polymyxin B, frequently used as a last resort against multi-drug resistant organisms.

They noticed that 7 of the 13 strains cultured with the Trigene, which were resistant to the disinfectant, also developed a resistance to the polymyxin B.

Acinetobacter, seen predominantly as a threat to immunocompromised patients, requires more than just conventional cleaning for microbial kill. Chlorhexidine gluconate soap or wipes can be effective in deactivating skin colonization, and ultraviolet light room treatments are required to clear it from surfaces.

The researchers noted that further investigation is required to understand why these resistances occur, and how they can be beaten.

David Bernard

InstaPoll: What's Your Busiest Day of the Week?

On which day of the week do you do the most cases? Tell us in this week's InstaPoll, then check back next week for the results.

Most of the 259 respondents to last week's InstaPoll say that when their patients arrive from home, they're not entirely ready to be wheeled back to the OR because not all their paperwork and pre-admission testing are completed. The results:

How ready are your patients for surgery when they arrive from home?

  • Not at all. We have to get them ready. 12%
  • 30% ready. Some work has been done, but we do most of it. 24%
  • 75% ready. They're mostly prepared, and we fill in the gaps. 58%
  • 100% ready: Our patients arrive gift-wrapped. 6%

Discuss this topic with your colleagues here.

Dan O'Connor

News & Notes
  • Benchmark online with ASCA A new online operational and clinical benchmarking program from the ASC Association provides national statistics for comparing and improving your center's outcomes, staffing and billing. Subscribers who submit their 1st and 2nd quarter data before Sept. 30, the deadline for processing those quarters, will be able to participate in all 4 quarters of 2013.
  • Bariatric surgery heart-healthy for teens Weight-loss surgery appears to correct enlarged hearts in adolescents, according to a study in the Journal of Pediatric Surgery. "We found that the cardiac structure and function in these extremely obese adolescents scheduled for bariatric surgery, was much more impaired than one might have thought," says study author John Bauer, PhD. "In addition, more than half of the patients we looked at had significant cardiac abnormalities that would be on par with a middle-aged person with real cardiovascular disease risk in the short term." Previously recorded cardiovascular abnormalities were reversed in 6 of the 10 patients after surgery.
  • Plastic complications spell readmissions Cosmetic and reconstructive surgery patients are far more likely to be readmitted if they suffer post-operative complications, according to a study published in Plastic and Reconstructive Surgery. Anemic and obese patients face a significantly higher rate of readmission. Studying 10,700 surgical patients from 2011, researchers at the Hospital of the University of Pennsylvania found that readmission risks were 6 times higher for those with surgery-related complications and 5 times higher for those with wound-related complications. Patients with anemia were 80% more likely to be readmitted and obese patients 20% more likely.